Errors Flashcards
What are appropriate antibiotic choices for a mild MRSA infection? (3)
TMP-SMX
Clindamycin
Doxycycline
How common is a retroverted uterus and does it have any effect on abortion risk?
11%
No it does not
What is apathetic thyrotoxicosis?
Atypical form of hyperthyroidism which may cause confusion, letheragy, and depression; more common in elderly and may be misdiagnosed as dementia
What is the most common cause of death in anorexia nervosa? What part of the vitals should be closely monitored then?
Cardiac complications, like arrhythmias, resulting from electrolyte abnormalities.
Many anorexic patients may be bradycardic at baseline so a HR of 60-100 can be ominous in them actually
What is the HIV screening tool?
What is that test confirmed with?
If the above are negative, possibly because it is too early in the HIV detection window, what tests are more definitive?
Screen: ELISA
Confirm: Western Blot
Definitive: HIV RNA PCR or p24 antigen detection
What is characteristic of Celiacs disease on duodenal biopsy?
Villous blunting with plasma cell and lymphocyte infiltrate
What Chlamydia treatments are contraindicated in pregnancy?
Doxycycline
Fluoroquinolones
Erythromycin Estolate (but not BASE)
What is primary treatment for Paget’s disease of bone?
Bisphosphonates
What are treatment options at reducing blood pressure in cocaine-related chest pain?
Phentolamine (alpha antagonist)
Nitroprusside
Nitroglycerin
Calcium pyrophosphate crystals in a joint cavity may be suggestive of what disorder?
Hemochromatosis
In patients with suspected disseminated gonococcal infection (e.g. with joint infection) what/where should you culture?
Culture from joint and mucosal surfaces i.e. cervical, rectal, oral mucosa
What is a unique finding/symptom seen in disseminated gonococcal infection?
Tenosynovitis
What are EKG findings of WPW?
Shortened PR interval
Delta Wave
Wide QRS
Patients with asthma may be susceptible to Aspergillus infections (i.e. allergic bronchopulmonary aspergillosis). What should be the initial test done when suspecting this diagnosis?
Skin prick and test for sensitivity to Aspergillus antigens. If this is negative the dx is very unlikely. If positive can move forward with additional tests like IgE measurement
What is tx for allergic bronchopulmonary aspergillosis? What if refractory?
Oral corticosteroids
If refractory than itraconazole
How long should infants with tubercular meningitis, miliary TB, or tuberculous osteomyelitis be treated?
12 months
When are patients considered non-infectious for TB?
When they’ve had 3 negative sputum samples on 3 different occasions
What complication of Strep pharyngitis is penicillin beneficial at lowering the risk of?
Acute Rheumatic Fever
How can you diagnose orthostatic proteinuria?
Compare spot urine protein:creatinine from supine and standing
OR
Split 24 hr urine collection over morning and night
In non-perforated toxic megacolon what is the initial mode of therapy?
Medical mgmt with oral steroids may prevent the need for surgery.
(This isn’t the case if the cause of the megacolon is C. diff)
In what situation may antibiotics be used for acute bronchitis?
In patients with COPD with increase sputum volume/purulence and/or dyspnea
Gastroesophageal reflux in infants is normal until what age, generally?
24 months
How can you confirm a diagnosis of HIT?
Serotonin Release Assay
Heparin-induced platelet aggregation assay
PF-4 Abs ELISA
What is necessary prior to surgery for removal of a pheochromocytoma?
10-14 days of pretreatment with alpha blocker, such as phentolamine or phenoxybenzamine and IV hydration long before surgery
What is the difference between phentolamine and phenoxybenzamine?
Phentolamine: reversible, non-selective alpha blocker
Phenoxybenzamine: irreversible alpha blocker
How do you manage intraoperative hypotension during resection of pheochromocytoma?
Normal saline bolus
Pressors if doesn’t respond
Describe the appearance of alopecia areata
Smooth, discrete area of hair loss with no adjacent scaling or inflammation (a discrete autoimmune attack)
What is the prognosis of alopecia areata in terms of hair regrowth? What is treatment?
Hair may regrow back but since it’s an autoimmune type disease it often recurs
Treatment is intralesional glucocorticoids but this doesn’t always cure the disease
Patient presents with suspected scaphoid fracture. How do you follow them up if the initial X-ray is negative?
Either get an MRI of the wrist, repeat x-ray in 7-10 days, or do a bone scintigraphy scan in 3-5 days
In patients with high suspicion of intussusception what is the diagnostic/therapeutic test you proceed with?
What if suspicion is low?
High suspicion: Air enema is diagnostic and therapeutic
Low suspicion: Do abdominal US and look for target sign
What risk does Lyme disease acquired during pregnancy confer on the infant?
Very little if treated appropriately
How is Lyme disease treated during pregnancy or inn children
Amoxicillin or cefuroxime
What are the 3 potential effects of amiodarone on thyroid function and how is each managed?
(i) Decreased peripheral conversion from T4 to T3: Pts are clinically euthyroid and can continue amiodarone; check TFTs later again
(ii) Hypothyroidism from decreased synthesis (amiodarone contained Iodine which disrupts synthesis) and elevated TSH. These patients need levothyroxine.
(iii) Amiodarone-induced thyrotoxicosis (type 1 and 2): AIT1 caused by increased synthesis and needs anti-thyroid drugs like PTU or methimazole
AIT2 is a destructive thyrotoxicosis and needs glucocrticoids
What defines positive proteinuria when doing urinalysis in pregnant patient looking for pre-eclampsia?
> 300mg/day
0.3 protein:creatinine ratio
1+ protein on dipstick
What is first-line therapy for patients with Raynaud’s phenomenon?
Amlodipine or Nifedpine
How do you manage patients with sickle cell disease and vaso-occlusive crisis initially in the inpatient setting?
Give opiates because extremely painful
Give gentle rehydration (1/2 or 1/4 NS) bc full NS may be tough on kidneys which may have difficulty excreting additional Na+)
What are maintenance therapies for patients with sickle cell disorder?
Vaccinations
Penicillin until age 5
Folate
Hydrooxyurea (most helpful in patients with recurrent vaso-occlusive episodes)
What is the treatment for acute chest syndrome in sickle cell patients?
Antibiotics (i.e. ceftriaxone and azithromycin)
Pain control
Hydration
What can reduce the risk of ear barotrauma related to diving?
Non-sedating decongestants like pseudophedrine
How is ASCUS managed differently in patients younger and older than 25?
Younger: repeat in a year
Older: HPV testing and then pending the results either colposcopy or another PAP and return to routine testing
When do you begin screening women with Pap smears?
21 yo
